Big Toe Joint Replacement

A first metatarsophalangeal (MTP) joint replacement treats arthritis of the big toe. The joint is removed and replaced with metal, plastic or both. The primary goal is to lessen pain. Another goal of the surgery is to retain motion and improve the position of your big toe.

Conditions

Although you may also need great toe replacement after an injury, more often the procedure is performed if you are dealing with the effects of rheumatoid arthritis or osteoarthritis, such as hallux rigidus, which is the growth of bone spurs on the great toe joint due to bones rubbing together. The main symptoms are pain and loss of motion at the joint between the big toe and the foot. Your doctor will examine you and take X-rays to determine the extent of your arthritis.

If you are older or have limited demands on your feet and your foot pain is interfering with your daily life—even while you are resting—you may be a good candidate for great toe replacement.

Surgery

Your doctor will perform a physical exam to assess the strength, range of motion, and condition of your great toe. To better understand the damage, your doctor may need X-rays taken of your foot.

Great toe replacement (for severe conditions):

• You will be given general anesthesia.
• An incision is made over your first MTP joint and carried down to the joint.
• Your doctor will remove your joint surfaces along with a small amount of bone from your arthritic joint.
• Bone spurs are removed.
• Your doctor will then open the canals of your bones and place the implants.
• Then your joint capsule and skin are closed with stitches.

Your deformity should be corrected during the surgery, as the implant will fail if it is not addressed. There are many different types and brands of implants. Your doctor will determine the proper one based on the evaluation.

Rehabilitation

What to expect during recovery:

• After surgery, a soft dressing of gauze and tape is placed over the toe and foot.
• The joint is initially immobilized but early motion is started to prevent stiffness.
• You will go to a recovery room where you will be monitored.
• When you wake up, your foot will be in dressing.
• Later, it will be placed in a cast or a boot.
• If needed, you will stay in bed until you can walk safely using a walker, cane or crutches.
• You will need to have your foot elevated as much as possible since this will help reduce swelling and improve wound healing.
• Physical therapy may be utilized to increase motion and strength at the first MTP joint. Stitches are usually removed 10 to 15 days after surgery.
• You will then wear a hard-soled shoe.

It may take up to eight weeks for you to be able to regularly bear full weight on the toe.